Can maternal unemployment harm an unborn baby?

Being born healthy has many long-term benefits. To date, we understand how a pregnant woman’s health and economic factors affect birth outcomes. We know about the adverse effects of smoking, substance abuse, low income, and low education of mothers. Researchers have reason to assume that these factors affecting mothers connect to employment. But is there a direct connection between employment status and birth outcomes?

Job loss may incite many consequences including stress, reduced healthy food choices, limited healthcare access, or risky behaviors such as substance abuse. Alternatively, it might reduce exposure to work stress or reduce consumption of unhealthy goods like alcohol and cigarettes.

These hypotheses underlie research by Helen Scharber in “Does ‘Out of Work’ Get into the Womb? Exploring the Relationship between Unemployment and Adverse Birth Outcomes.” She examines how the change in maternal employment status between childbirths affects birth outcomes, focusing on the probability of low birth weight, defined as less than 2,500 grams, and the probability of infant death. The analysis includes 1,344,605 infant birth and death records in Texas between 1994 and 2003.

To remove confounding influences on birth outcomes, Scharber controls for gender, birth order, and mother’s demographic characteristics. Irrespective of these factors, she finds a statistically significant relationship between unemployment and negative outcomes. Gaining work has a bigger effect on birth weight and infant mortality than losing work.

Scharber’s analysis also explores possible mediating factors in the causal link between unemployment and infant health, including smoking, healthcare access, medical risk factors, and gestation length. The analysis suggests that reduced gestation may drive the employment-infant health relationship. Factors such as adoption of unhealthy behaviors, loss of access to food, or loss of access to prenatal care, have less of an effect.

Previous research has shown that stress reduced gestation length. However, it is not the history of certain events that affects gestation, but women’s perception of these events as stressful. Scharber uses self-reported employment, thus, analyzes how women perceive their own status. Her results support the hypothesis that job loss acts as a stressor affecting gestation length. In turn, reduced gestation results in the birth of lighter, less healthy babies. In 2005 Dooley & Prause reported similar results for the above-mentioned mediators. Their research provided a foundation for Scharber’s paper. However, they explored self-reported employment status during pregnancy, rather than between pregnancies.

Scharber further examines the effect of medical risk factors and number of prenatal care visits on the employment-health relationship of mothers. Medical risk factors include anemia, cardiac disease, lung disease, diabetes, and others. Research shows that unemployment correlates with worse birth outcomes only when mothers have some sign of a difficult pregnancy. This result implies that unemployment does not have a unified effect on health. It only hurts fetuses when the mother is already at risk for pregnancy complications.

The relationship between stress and reduced gestation raises important policy concerns. Policy makers must address employment protection for pregnant women with medical risks or who use prenatal care services very often. However, we lack information for further proposals, since the study has limitations.

First, the study does not eliminate the possibility of reverse causation. Pregnancy complications and poor health may cause unemployment, not vice-versa. In this case, there may still be improvements to be made to labor laws. For example, more generous policies for sick leave and keeping positions for pregnant women could be necessary. Second, mothers may have been more likely to report unemployment when it happened for health reasons. This may have biased the results of the study. In this case, only further research can shed the light on results attained by Scharber’s study.

Article Source: Helen Scharber. Does ”Out of Work” Get into the Womb? Exploring the Relationship between Unemployment and Adverse Birth Outcomes. Journal of Health and Social Behavior 2014 55: 266 DOI: 10.1177/0022146514543799

Feature Photo: cc/(kara)